REGULATORY ACTIVITY:

• Colorado posted that Rule 17 Exhibit 5 Cumulative Trauma Conditions Medical Treatment Guidelines Revised December 29, 2016 have become effective as of March 2, 2017.

LEGISLATIVE ACTIONS:

• House Bill 17-1048
  This bill makes changes to the language defining insurance fraud. It changes the statute of limitation for this offense, specifying that the period within which a prosecution must begin starts with discovery of the criminal act. The bill also adds insurance fraud to the list of crimes that may constitute racketeering activity. Effective Date: August 10, 2017.

• Senate Bill 17-146
  The enacted statute modifies provisions relating to licensed health professionals' access to the electronic prescription drug monitoring program as follows: allows a health care provider who has authority to prescribe controlled substances, or the provider's designee, to query the program regarding a current patient, regardless of whether the provider is prescribing or considering prescribing a controlled substance to that patient; specifies that a veterinarian who is authorized to prescribe controlled substances may access the program to inquire about a current patient or client if the veterinarian suspects that the client has committed drug abuse or mistreated an animal; and specifies that, in addition to accessing the program when dispensing or considering dispensing a controlled substance, a pharmacist or designee of the pharmacist may access the program regarding a current patient to whom the pharmacist is dispensing or considering dispensing a prescription drug. Effective Date: August 10, 2017.

REGULATORY ACTIVITY:

• Colorado posted corrections to the Medical Fee Schedule Excel spreadsheet. This correction was limited to the a few procedures covered under the “Medicine Section Conversion Factor $67.00” that should have been calculated using "PM&R Section Conversion Factor $41.14".  The code range for this correction is: 97610-97814. The corrected spreadsheet has been posted to the website under the spreadsheet name:  2017_CO_MFS_01_19_2017.

FEE SCHEDULE NEWS:

• The Medical and Facility fee schedule has been updated as of January 1, 2017. The physician fee schedule is based on the 2016 Medicare Resource Based Relative Value Scale (RBRVS), except as prescribed by the rule, and conversion factors. The Inpatient Hospital Fee Schedule has adopted Version 34 of the MS-DRG in addition to new MS-DRG values. Outpatient Hospital Fee Schedule is based on the Medicare’s revised Addendum B from January 1, 2016.
• The next fee schedule update is scheduled for January 1, 2018.

REGULATORY ACTIVITY:

• A notice of a public hearing was given to afford all interested persons an opportunity to be heard prior to the adoption of proposed amendments to the Workers’ Compensation Rules of Procedure, 7 C.C.R. 1101-3.  The Director of the Division of Workers’ Compensation has the authority to promulgate rules pursuant to the Workers’ Compensation Act as set forth in section 8-47-107.  The date and time of hearing is December 19, 2016 9:30 a.m. at 633 17th Street, 12th Floor Denver, CO. The public hearing will be held in accordance with the provisions of the Colorado Administrative Procedures Act, section 24-4-103, CRS.  Any interested party is invited to appear at the hearing and testify or to submit written data, arguments or position papers to Paul Tauriello, Director, Division of Workers’ Compensation, 633 17th Street, Suite 400, Denver, CO 80202.  Any written submissions should be submitted to the Director prior to the hearing.  The topics to be considered are:  Rule 17, Exhibit 5 – Cumulative Trauma Conditions. The proposed rule changes were available at the Department’s website on or before November 15, 2016.  Copies of the proposed rules were also available by request on November 15, 2016 at the Division’s Customer Service Office, 633 17th Street, 4th Floor, Denver, Colorado.
• Colorado has issued an interpretive bulletin for the 2017 Fee Schedule.

LEGISLATIVE ACTIONS:

• House Bill 16-1323
  This bill changes the name of the Division of Labor and Employment within the Colorado Department of Labor and Employment (CDLE) to the Division of Labor Standards and Statistics. Effective Date August 10, 2016.
• Senate Bill 16-158
  The bill clarifies and expands the duties that a physician may delegate to a physician assistant within his or her scope of practice, including allowing physician assistants to:
  • issue certain statements verifying a medical condition;
  • obtain Level I accreditation in workers’ compensation matters;
  • qualify as providing direct access to a health care provider under health insurance plans in regards to several conditions where direct access is mandated in law;
  • work under the direction and supervision of a podiatrist (up to four physician assistants per podiatrist) ;
  • serve as a public health director for a county or district board of health; and
  • issue certificates of immunization or medical exemptions to immunizations for K-12 and university students. In addition, the bill requires that prescriptions for schedule II controlled substances issued by a physician assistant be imprinted with the name of the supervising physician or podiatrist.  All other prescriptions issued by physician assistants must be imprinted with the name and address of the facility where the physician assistant practices.  Effective Date August 10, 2016.
• Senate Bill 16-217
  This bill establishes new requirements concerning the reduction of workers’ compensation payments in cases that involve an admission of liability (known as safety rule violations) by an employer and propose to reduce the amount of compensation paid to a claimant.  Under the bill, any reduction in compensation must include a statement from the employer listing the specific facts on which the reduction is based.  If the insurer or self-insured employer admits liability for the claim, any party may request an expedited hearing if the application is filed within 45 days.  The director of the Colorado Department of Labor and Employment (CDLE) is required to schedule the hearing within 60 days of the date of the application.  If the party does not request an expedited hearing, the hearing must be set according to provisions under current law.  Under the bill, the time frame for conducting any expedited hearing is extended from 40 days to 60 days from the date of application and the bill permits a party to request an expedited hearing on the question of whether a compliant designated medical provider list was provided. The bill allows the CDLE to provide a standardized form to be used by the injured employee to request that his or her personal physician or chiropractor provide treatment or to request a change of physician.  If an injured employee is permitted to change physicians, the bill clarifies that the initial physician’s relationship with the employee terminates once he or she visits the new physician. In addition, the initial physician’s authorized work restrictions and return to work opinions control until such time that a new physician expressly modifies them.  This bill may alter workers’ compensation claims paid by insurers.  To the extent that this increases or reduces the amounts paid in premiums by state or local government employers, these impacts have not been estimated.  Hearings within the CDLE are conducted by administrative law judges who are under the auspices of the Department of Personnel and Administration. This bill is expected to affect the timing and frequency of hearings conducted by the CDLE for workers’ compensation claims. As of this writing, the increases and reductions in workload are not anticipated to result in adjustments in appropriations for any state agency.  The bill creates the right to request expedited hearings for safety rule violations and change of physician issues.  This is expected to result in additional hearings. Workload will also increase for the CDLE to develop the standardized medical forms; this workload increase is minimal.  Workload for administrative law judges may be reduced by a minimal amount as a result of several factors.  Extending the time period that expedited hearings must be held from 40 days to 60 days reduces workload. By requiring that an employer provide documentation prior to reducing claimant wages, the bill may reduce other hearing requests from certain existing claimants whose wage replacement has been lowered.  Creation of a standardized medical form and clarification about when a physician relationship with an injured employee terminates may also reduce requests for hearings.  To the extent that this bill alters the amount of payment for certain workers’ compensation claims or reduces the workload associated with those claims, it would potentially affect underwriting practices or premiums for Pinnacol Assurance, a statutory public entity. Effective Date June 10, 2016.
• Senate Bill 16-198
  This bill adds advisory organizations and rating organizations to the list of entities required to comply with current law regarding submission of policy forms, which may include any endorsement, rider, letter, notice, or other document affecting an insurance policy or contract. These materials are to be submitted to the Commissioner of Insurance in the Division of Insurance (DOI) within the Department of Regulatory Agencies via an annual report due by July 1 of each year.  The annual report must include certification that the documents are, to the best of an officer’s knowledge, in compliance with Colorado law.  If a workers’ compensation carrier uses forms, without modification, prepared by an advisory or a rating organization, the carrier is required to notify the DOI that it adopted the annual report filed by the advisory or rating organization and does not have to submit its own certification. Every carrier, advisory organization, and rating organization must also submit a list of any new or revised policy forms as may be requested by the DOI at least 31 days prior to their use. Unless a carrier notifies the DOI otherwise, policy forms submitted on behalf of a member of an advisory or rating organization are deemed to be automatically adopted by the carrier without modification. Effective Date June 8, 2016.